Provider Demographics
NPI:1952062176
Name:KAHANOWITCH, TAYLOR JAMES
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JAMES
Last Name:KAHANOWITCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 LAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2023
Mailing Address - Country:US
Mailing Address - Phone:805-558-4951
Mailing Address - Fax:
Practice Address - Street 1:4165 E THOUSAND OAKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3837
Practice Address - Country:US
Practice Address - Phone:805-371-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor